Anatomy of large blood vessels – veins Lecture 3 Please check our Editing File { َوَم نْ يَ َت َو َ ّكْ عَ َلْ ا َ هّْلل فَهُ َوْ َح س ْ ُب ُهْ} هذا العمل ﻻ يغني عن المصدر اﻷساسي للمذاكرة Objectives ● Define the veins, and understand the general principle of the venous system. ● Describe the superior & inferior Vena Cava (formation & their tributaries) Head & neck Thorax & abdomen Upper & lower limbs ● List major veins and their (formation & tributaries in the body) ● Describe the Portal Vein (formation & tributaries in the body) ● Describe the Portocaval Anastomosis (formation, sites & tributaries in the body) Veins ● Veins are blood vessels that bring blood back to the heart. ● All veins carry deoxygenated blood - with the exception of the pulmonary veins (open in the left atrium) and umbilical vein (during fetal development). Vein can be classified in 2 ways based on Location Circulation Superficial veins: Veins of the systemic Deep veins: found close to the surface of circulation: Veins of the portal deeper in the body the body Superior and Inferior circulation: -With corresponding -NO corresponding vena cava with their Portal vein arteries arteries tributaries Vena Cava ONLY in boy’s slides ● They are two large veins that return deoxygenated blood from the body into the heart. ● There are the superior vena cava and the inferior vena cava. ● Both empty into the right atrium. ● They are located slightly off-center toward the right side of the body. Superior vena cava ❖ The superior vena cava is above the heart of the right and left ’اتحاد“ Formed by the union ❖ Brachiocephalic veins. -Brachiocephalic veins are formed by the union of internal jugular and subclavian veins. ❖ Drains venous blood from : Head & neck, Thoracic wall ,Upper limbs ❖ It Passes downward and enter the right atrium. ❖ Receives azygos vein on the posterior aspect just before it enters the heart. Veins of Head & Neck Superficial Veins of Head & Neck Superficial Veins ❖ External Jugular Vein: - Lies superficial to the sternomastoid muscle External Jugular veins - Formed by the union of posterior auricular vein and retromandibular vein. Anterior jugular veins - Begins just behind the angle of mandible by Deep Veins union of posterior auricular vein with the posterior division of Internal Jugulars veins. retromandibular vein. - It passes down the neck and it is the only tributary. Deep of the subclavian vein. - It drains blood from: Superficial 1- Outside of the skull 2- Deep parts of the face. Superficial Veins of head & neck ❖ Anterior jugular veins: - It begins in the upper part of the neck by the union of the submental veins. - It descends close to the median line of the neck, medial to the sternomastoid. - At the lower part of the neck, it passes laterally beneath sternomastoid muscle to drain into the external jugular vein. - Just above the sternum the two anterior jugular veins communicate by a transverse vein to form the jugular arch. Deep Veins of head & neck ❖ Internal Jugular vein: - Drains blood from the brain,face, head & neck. - It descends in the neck along with the internal and common carotid arteries and vagus nerve, within the carotid sheath. - Joins the subclavian vein to form the brachiocephalic vein. - Tributaries ‘branches’: 1-Superior thyroid 2-Lingual 3-Facial 4-Pharyngeal. 5-Occipital veins 6-Dural venous sinuses (inferior petrosal sinus). - These veins drain blood from anterior face, trachea, thyroid, esophagus, larynx, and muscles of the neck. Venous disorder ONLY in boy’s slides ❖ INFARCTION : - Refers to tissue death (necrosis) that is caused by a local lack of oxygen due to obstruction of the tissue's blood supply ❖ SINUS THROMBOSIS : - SSS thrombosis ● Superior Sagittal Sinus ● Can complicates ear infection - Cavernous Sinus thrombosis ● As a complication of infection in the dangerous area of the face - Obstruction of venous drainage of the brain leads to Cerebral swelling (edema) and raised Intracranial Pressure. Veins of upper limb Veins of Upper Limbs Superficial Veins Cephalic vein Basilic vein Deep Veins Venae commitantes Axillary vein 1-Superficial Vein Veins of upper limbs Cephalic vein ➔ Arize from the dorsal venous network of the hand ➔ Ascends in the superficial fascia on the lateral side of the biceps (antero-lateral aspect of the upper limb, passing anteriorly at the elbow). ➔ At the shoulder, the cephalic vein travels between the deltoid and pectoralis major muscles to enters the axilla region via the calvipectoral triangle. ➔ Drains into the Axillary vein. (note that Cephalic is a tributary of the axillary vein) Basilic vein ➔ Originate from the dorsal venous network of the hand. ➔ Ascends in the superficial fascia on the medial side of the biceps. ➔ Halfway up the arm, it pierces the deep fascia ➔ At the lower border of the teres major it joins the venae comitantes of the brachial artery to form the Axillary vein. Veins of upper limbs 2- Deep Veins The deep veins of the upper limb are situated underneath the deep fascia. Venae Commitantes (paired veins that accompany one artery) ➔ Which accompany all the large arteries and are usually in pairs. ➔ The brachial veins are the largest in size, and are situated either side of the brachial artery. ➔ Ulnar and radial veins are vena comitantes of ulnar and radial arteries. ➔ The pulsations of the brachial artery assists the venous return. ➔ Perforating veins run between the deep and superficial veins of the upper limb, connecting the two systems together. Axillary Vein ➔ Formed by the union of basilic vein and the venae comitantes (brachial veins) of the brachial artery. Veins of upper limbs ONLY in boy’s slides 2- Deep Veins Subclavian Vein ➔ Each subclavian vein is a continuation of the axillary vein and runs from the outer border of the first rib to the medial border of anterior scalene muscle. ➔ It then joins with the internal jugular vein to form the brachiocephalic vein. ➔ The subclavian vein follows the subclavian artery. ➔ The right and left brachiocephalic veins form superior vena cava that enters right atrium. anterior to the middle ‘ Pulse points in the upper limb ONLY in boy’s slides AXILLARY PULSE Located inferiorly of the lateral wall of the axilla. BRACHIAL PULSE Located on the inside of the upper arm near the elbow, frequently used in place of carotid pulse in infants (brachial artery). ONLY in boy’s slides ULNAR PULSE Located on the medial of the wrist (ulnar artery). RADIAL PULSE Located on the lateral of the wrist (radial artery). It can also be found in the anatomical snuff box. Clinical significance ONLY in boy’s slides VENEPUNCTURE ● The practice of obtaining intravenous access. This can be for intravenous therapy or obtaining a blood sample. ● The main vein used in venipuncture is the median cubital vein. ● It is a superficial vein that is situated anteriorly at the cubital fossa region. ● It is commonly used due to its accessible and superficial position. Inferior vena cava ● Drains most of the blood from the body below the diaphragm to the right atrium. ● Formed by the union of the two common iliac veins behind the right common iliac artery at the level of the 5th lumbar vertebra. ● Ascends on the right side of the aorta. ● Pierces the central tendon of diaphragm at the level of the 8th thoracic vertebra. ● It is the largest vein in the human body. ● Travels up alongside abdominal aorta with blood from lower part of the body. Tributaries of Inferior Vena Cava IMPORTANT 1. Two common iliac veins 2. Median sacral vein 3. Four paired lumbar veins 4. Right gonadal vein (the left vein drains into the left renal vein) 5. Paired renal veins 6. Right suprarenal vein (the left vein drains into the left renal vein) 7. Hepatic veins 8. Paired inferior phrenic veins. Veins of lower limb Superficial veins Deep veins ● Form a network in the ● Comprise the venae subcutaneous tissue. comitantes, which accompany ● Pattern is variable all the large arteries, usually in ● They are the tributaries of the: pairs. - Great (long) saphenous vein ● Venae comitantes unite to - Small (short) saphenous vein form the popliteal vein, which continues as the femoral vein. ● Deep veins Receive blood from superficial veins through perforating veins. ● Including: o Anterior and posterior tibial veins o Popliteal vein o Femoral vein Superficial veins of lower limb Great saphenous vein ● The longest vein ● Begins from the medial end of the dorsal venous arch of the foot ● Passes upward in front of the medial malleolus with the saphenous nerve. ● Then it ascends in accompany with the saphenous nerve in the superficial fascia over the medial side of the leg ● Ascends obliquely upwards, and lies behind the medial border of the patella. ● Passes behind the knee and curves forward around the medial side of the thigh. ● Hooks through the lower part of the saphenous opening in the deep fascia to join the femoral vein about 1.5 in. (4 cm) below and lateral to the pubic tubercle. Superficial veins of lower limb ONLY in girl’s slides Great saphenous vein ● It is connected to the small saphenous vein by one or two branches that pass behind the knee. ● It is connected to the deep veins by numerous perforating veins. ● The perforating veins have valves which allow blood flow from superficial to deep veins. ● It is clinically significant in coronary bypass surgery and in intravenous delivery of fluids due to venous collapse. ● The great saphenous vein is used in venous grafting and saphenous vein cutdown may be necessary for inserting the neddle or canula (take care of the saphenous nerve). Superficial veins of lower limb Small saphenous vein ● Arises from the lateral end of the dorsal venous arch. ● Ascends behind the lateral malleolus in company with the sural nerve. ● Ascends along the lateral border of the tendocalcaneus and then runs up to the middle of the back of the leg.